Guidelines for Suprapubic Catheterisation in Children

Suprapubic catheter insertion, which is also known as suprapubic catheterization, is a procedure during which a catheter that is designed to drain the bladder or urine is placed in the bladder via the abdomen. If performed on a child or a young person, then the patient may be put under general anesthetic. If the patient is in some manner serious ill or in a weakened state, the procedure may be done using a local anesthetic.

Once suprapubic catheter placement is complete, it is often secured to the abdomen by suturing it at skin level and utilizing a hypoallergenic latex free dressing. There is no dressing required unless there is urine leakage or bleeding.

Size of Catheters

There are various types of catheters, including Foley™ and Cystofix™, that may be used. To effectively empty a bladder, the smallest sized catheter should be inserted. A knowledgeable and experienced surgeon will be able to decide what size and type of device will work best. Deciding factors will include the size and age of the patient, the intended use, and any complicating factors.

Why a Suprapubic Catheter Mat be Used

There are many different reasons as to why someone may be a candidate for suprapubic catheterization. These include:

• Following surgery or an acute illness, to correctly calculate and manage fluid balance.
• To promote the healing of the wound following bladder neck surgery.
• After bladder neck or bladder surgery to reduce pressure and minimize or present leakage of urine.
• To allow for urinary drainage over the long-term.
• In order to facilitate radiological and urodynamic investigations.

The procedure should only be performed on children when absolutely necessary. The duration for this type of device should be three to 28 days, however for some children long-term use may be in order.

Important Considerations

Please consider the following important points when introducing a suprapubic catheter to a child.

• These devices are managed without directly touching them and require proper instruction.
• It is highly recommended that non-latex catheters be used.
• Despite being given an appropriately sized catheter and having it correctly positioned, many children will feel discomfort.
• Children should be given prescribed analgesics.
• Bladder spasms, with symptoms including burning and cramping pain in the lower abdomen, may be experienced.
• Anti-spasmodic medication may be used to curtail these symptoms.

Information to Relay

The surgical team is charged with informing the family, including the child, of the following:

• The catheter is necessary.
• Why suprapubic catheter insertion is being done.
• The steps involved in the procedure.
• How long the procedure is likely to take.
• How long the device will be in use.

The outlined discussion is to be documented in the patient’s health care record. It may be suitable to utilize a play specialist in order to prep the child. Children should also have access to written information concerning suprapubic catheters.

Caring for the Catheter

The following points should be observed:

• Use hypoallergenic, latex free adhesive strapping when securing the catheter to the abdomen.
• Also check the stabilizing suture and strapping when emptying the drainage bag.
• When bathing the child do not get the entry area wet.
• Shallow water baths should be utilized.
• Each day monitor the entry site for signs of trauma and infection.
• Any discharge, bleeding, swelling, etc., should be recorded.
• Examination of suspected infection should be done as soon as possible.
• If bleeding or discharge occurs, clean the entry area using aseptic non-touch technique.

1. Explain the procedure to the family and child
The container of 0.9% sodium chloride should be placed in a bowl of warm water
2. Put on apron and wash and dry hands thoroughly
3. Remove dressing from wound area
4. Clean adhesive off with remover
5. Open the dressing and prep
6. Take container of 0.9% sodium chloride from water and dry
7. Add solution to gauze
8. Apply gel to hands and put on gloves
9. Using non-dominant hand, take hold of catheter with sterile gloves
10. Take gauze soaked with 0.9% sodium chloride and carefully wipe the site
11. With a new piece of gauze dry the site, patting it gently
12. Secure catheter once again.
13. Dispose of all waste and used equipment in a safe and appropriate manner
14. Document procedure in child’s health care record

Catheter Removal

In removing the suprapubic catheter, the following supplies and equipment will be needed:

In removing the device, it is important to discuss the procedure with the child and family.

1. One-half hour before the procedure, an analgesic should be given as prescribed.
2. Empty drainage bag
3. Catheter should be placed on free drainage
4. Put on an apron
5. Wash and dry hands in appropriate manner and put on gloves
6. Remove restraining suture
7. With adhesive remover, carefully take the strapping off the child’s abdomen, as you support the catheter.
8. Insert a syringe to deflate balloon
9. Withdraw sterile water with syringe
10. Take hold of the catheter at entry area
11. Have the child take deep breaths
12. As the child exhales, carefully and gently pull out the catheter using one, steady move.
13. Once catheter is removed, apply pressure to area for a minute in order to aid in closure of abdominal wall and bladder
14. Cover area with gauze and affix with tape.
15. Dispose of all materials in an appropriate manner
16. Take off gloves and carefully wash and dry hands
17. Document procedure in health care chart.
18. Record procedure in the child’s health care records

Inform the doctor if there are signs of infection, any step in the procedure cannot be properly performed, or, if later, the child cannot pass urine. Also, any leaks at the site, signs of infection, or other abnormalities should be reported. After the procedure, carefully monitor the site for bleeding or leakage. After 24 hours, remove the dressing.

Informing Children and Specific Procedural Standards

As noted, when a child has a suprapubic catheter there are specific procedures to follow and child-specific steps to take. Always keep the child informed regarding the procedures.